“My son, he’s real bad off.  He needs to go to the hospital.”

The smell of urine had struck me in the face like a big wet towel when I walked in the trailer.  The floor was spongy beneath my feel.  The amount of useless Walmart consumer crap stacked up on every horizontal surface and against the walls was overwhelming.  I didn’t want to get anywhere near it.  Previous experience tells me that spiders usually inhabit obsessive collections of garbage like this.  I was standing in what served as a living room.  There were two coffee mugs being used as ashtrays.  They were overflowing onto the coffee table.  At least I thought it was a coffee table.  There were so many empty TV dinner trays piled on it that I was only assuming its function.

“What’s wrong with him?” I asked.  I glanced at the TV.  An old John Wayne DVD was paused.  It looked like ‘She Wore a Yellow Ribbon’.  It was odd to see one of my old favorites in a trailer like this.  If I was in a better mood I might have used my familiarity with it as an ice breaker.  But I was too disgusted and I just wasn’t having it.

“He’s paralyzed.  The poor boy can’t move a thing.”  I was listening to his words, but I couldn’t get past the wound on his forehead.  It was staring at me like a third eye.  He had some sort of psoriasis outbreak on his forehead.  He had been picking at it with dirty fingers and it was infected.

“Well, let’s go talk to him.”  As we walked towards the hall I noticed the various porn calendars that adorned the walls of the living room.  Classy.

The bedroom was in no better shape than the living room.  The man’s son was in his 30’s.  He was lying stiff on the bed.  Artificially stiff.  His eyesight must have been terrible.  He was wearing eyeglasses as thick as coke bottle bottoms.  They magnified his eyes to the point where I imagined that I could peer back into his retinas if I spent enough time to get the right angle.

“What’s up, man?”  I know.  The beginning of my exam lacked luster.

“Something happened to my spine.  My back is killing me and I can’t move my arms or my legs,”  he said.

“Really?  Have you had any sort of recent trauma?  Did you fall today?”

“No, but I was working at Kroger all this week.  I’ve been wondering if I don’t have that repetitive motion syndrome or something!”

“So you can’t move your arms or your legs, eh?”

“Nope, I can’t move ‘em at all!”

I looked at the BLS crew who had come in with me.  I shot them a look that contained my best attempt at a look of deep concern.  It must not have worked.  They were just trying hard not to laugh.

“Okay, sir.  I will have to do a neuro assessment on you, and I want you to tell me if anything hurts.”  I proceeded to poke at various random places where it looked like I wouldn’t encounter any sort of psoriasis or stain.  He was committed to not moving, so I decided to turn up the heat.  “Sir, I can’t rule out an injury so we are going to have to put you in a collar and board.”  One of my partners left on cue to go get the equipment.  I leaned in closer to continue my exam.  “Oh, hey,”  I asked  “do you mind holding my clip board for a moment?  There is no where to set it down.”

He fell for it.  He grabbed my clip board with his left hand and held it up in the air.  He was careful not to take his arm away from his side on the bed, but he was holding my clip board upright.  I turned around to my partner who had remained in the room and did a victorious ‘Price is Right’ model wave to display my new clinical finding.  He was still holding it when the other EMT came back with the c-spine equipment.  He instantly cracked a smile upon seeing it.

“Alright sir, we are going to get you packaged up and out of here.”

I moved around to the other side of the bed to help place the board.  There was so much trash piled on the floor I was having trouble finding a place to set my feet.  Then I encountered a 5-gallon Home Depot bucket.  Believe it or not, my olfactory senses had adapted to the smell of urine since I first entered the house.  But now the smell was back and I noticed that the bucket was about two thirds full of liquid.

“Hey, what’s in the bucket?”  I inquired.

“That’s where I pee at night, when I don’t want to get up to go down the hall.”

“Really?”  I was trying to think of a passive aggressive comeback, but I had nothing.  I was just trying to avoid knocking it over.

The c-spine packaging went pretty well considering.  There weren’t any sheets on the bed, so the board slid well on the yellow stained mattress.  I have to admit though, by the time we were done we was holding the clip board in one hand, a pen in the other, and he had lifted his feet a couple of times at my request.  Don’t look at me like that.  How else are we going to get him to the middle of the board?

“What’s takin’ so long?”  Forehead-sore man was back and apparently we were taking too much time.  He brought a previously unseen dog with him just to make sure we would have something under our feet while we carried this overweight guy down the narrow hallway.  I looked down and the dog was just as disgusting as they were.  He looked a bit like a poodle mix but his coat was full of dust and matted.  It looked as if random chunks had been shaven out of his coat.  He was barking and nipping at our heels.

“Well its kinda hard to maneuver back here.  There is just too much trash.  I had to move your Home Depot urine bucket.  This is taking a little longer than I thought it would.  Are we interrupting your movie?”  I turned around and took a few steps toward him, leaned forward, and looked in his eyes while I said this.

The color from his face drained and he immediately left the room.  Mission accomplished.  However, he left the mangy dog behind.

We all grabbed a handle on the backboard and started down the hall.  At one point I had to stop because I thought my right foot had gone through the floor.  I overcompensated and slammed against the opposite wall that was only about three inches away.  The dog thought this was some sort of aggression and started going at it.

“Damnit dog! Shut up! Shut up!”  Our patient was yelling at the filthy ceiling.

I was getting a little thin with this, “Hey!”  I shouted back, “that’s enough.  I have been doing this for 15 years and not once has yelling at a dog ever gotten it to shut up.  You’re just adding to the noise.  Just lay there and be quiet, and we’ll get through this.”

We were getting closer and closer to the door.  Believe it or not, the patient was still holding the clip board.  We went out the door to a waiting cot and placed the backboard on it, relieved that we didn’t have to carry him anymore.  This was just too much for the dog though, he was reaching critical mass.  The barking was deafening.

“I can’t stand this anymore!”  yelled the patient with a psychotic lisp.  “Dad, go get the BB gun and shoot this dog in the ass.  He needs to go away or I am going to fall.”

“That’s enough!”  I yelled.  I found myself being more authoritative than I wanted to be.  At this service we encounterd the great unwashed on a daily basis and we were given a little latitude to correct and redirect people.  Saying ‘sir’ or ‘ma’am’ constantly and working on the premise that the customer is always right in this area was just not an option.  However, I was reaching the bleeding edge of my patient redirection limits and I was trying in vain to dial it back a notch.  “If either of you produces any sort of BB gun to shoot this dog I will be filing a police report and I’ll have the SPCA and animal control out here in the morning.  Is there any part of that you don’t understand?”

The patient was silent, and the father was looking at his toes.

“Alright then, I don’t want to hear another word from either of you.  This is ridiculous.  Now give me back my clip board Mr. Paralyzed.”  He held it over his head to reach me.

Loading them into the ambulance was thankfully a silent affair.  One of the crew members poked his head out the back door with a big grin.  “Will you be accompanying us, sir?”

“This is so fucking BLS,” was all I could manage.

He laughed and closed the door.  They drove off into the darkness that was 3am.  I got back in my response vehicle.  The heater was on and it was warm inside.  The night was still.  The only visible dwelling was the trailer we just exited.  Now that I was outside, I could see that it was leaning slightly to the left.

The dog ran up and put his front paws on the window, wagging his tail.  His aggression was completely gone.  I put on a glove, rolled down the window, and patted him for a minute.  He was grateful.  He wasn’t on a chain.  There was no fence.  It was dark and cold, and no one else was around.  For the first time in my career I considered stealing the possession of one of my patients.  “You want to come home with me and have a bath little guy?”  The dog looked at me expectantly.  My mischievous  thought left just as soon as it came though.  “There is nowhere at the station to keep you till morning my mangy friend.  And there is probably a special plane in hell for paramedics who steal a patient’s dog .  There is probably a much bigger plane in hell for dumbass rednecks that shoot dogs with BB guns.  Sorry my friend, you are on your own.”

I drove off into the night listening to Woody’s Roadhouse.